Inequalities in maternal pertussis vaccination uptake: a cross-sectional survey of maternity units.

Background: This study aims to estimate pertussis vaccine uptake in pregnant women in England, describe timing of vaccine delivery and examine variations in uptake. Methods: Cross-sectional survey of vaccine uptake in women delivering in maternity units in England. Variation in uptake described according to geography, maternal age, ethnicity and parity as reported by the midwife completing the survey. Results: A total of 1325 surveys were returned, 85% of which (1128) contained information about vaccination. Vaccine uptake was 61.8% (95% CI: 56.8-66.5) and was higher in the White British ethnic group than any other (67.7%, 95% CI: 63.5 to 71.5). Uptake was higher outside London (65.3%, 95% CI: 61.1-69.3) than within London (31.0%, 95% CI: 24.9-38.0). Reported uptake was lower in areas of high deprivation, and in women of higher parity, observations that were not statistically significant in the multivariable model. Overall, 74% of women were vaccinated between 28 and 32 weeks. Conclusions: Pertussis vaccine uptake in pregnant women varies significantly across the country and is affected by ethnicity, deprivation and parity. Variations should be addressed through service delivery models designed to reduce potential inequalities in infant protection.

Risk factors for pertussis in adults and teenagers in England.

Pertussis is a vaccine-preventable respiratory infection caused by Bordetella pertussis which can be fatal in infants. Although high vaccine coverage led to prolonged disease control in England, a national outbreak of pertussis in 2011 led to the largest increase in over two decades, including a marked increase in cases aged ⩾15 years. A case-control study in four regions of England was undertaken to investigate risk factors for pertussis in adolescents and adults, specifically employment type and professional and household contact with children. Pertussis cases were laboratory-confirmed and aged ⩾15 years. Controls were recruited through general practitioner nomination. Demographic and risk factor information were collected using an online survey. Multivariable logistic regression was used to estimate independent associations with outcome. Two hundred and thirty-one cases and 190 controls were recruited. None of the four employment variables (social care, education, health sector, patient contact) were significantly associated with pertussis. Professional contact with children aged < 1 year was associated with a significantly reduced odds of pertussis [odds ratio (OR) 0·25, 95% confidence interval (CI) 0·08-0·78, P = 0·017]. Household contact with ⩾1 child aged 10-14 years was associated with significantly increased odds of pertussis (OR 2·61, 95% CI 1·47-4·64, P = 0·001). Occupational contact with very young children was associated with reduced odds of pertussis, probably due to immune boosting by low-level exposures to B. pertussis. Sharing a household with a young adolescent was a significant risk factor for pertussis in adults and older teenagers. The primary focus of the childhood pertussis vaccination programmes is to prevent infant disease. Although evidence is emerging that adolescent vaccination does not provide indirect protection to infants, our results highlight the importance of children aged 10-14 years in pertussis transmission to older adolescents and adults.

Epidemiology and microbiological characterization of clinical isolates of Staphylococcus aureus in a single healthcare region of the UK, 2015.

We investigated the epidemiology and characterization of isolates of Staphylococcus aureus within the Yorkshire and Humber (YH) region in the UK. In July 2015, each laboratory within YH (n = 14) was assigned two consecutive days during which all clinical isolates of S. aureus were collected. Isolates were tested for antibiotic susceptibilities and the presence of genes encoding methicillin resistance (mecA and mecC), Panton-Valentine leukocidin (PVL) (lukS-PV), and efflux-mediated chlorhexidine resistance (qacA); isolates were also characterized by spa-types. Minimum inhibitory concentrations (MICs) to chlorhexidine were determined by the broth dilution method. Of 520 isolates collected, 6·2% were methicillin-resistant S. aureus (MRSA, all mecA-positive) and mupirocin resistance was low [0·8%, 95% confidence interval (CI) 0·3-2·0] and only found in MRSA. Carriage of the qacA gene was identified in 1·7% (95% CI 0·8-3·3) of isolates and 3·5% (95% CI 2·2-5·4) had a chlorhexidine MIC of 4 mg/l. The PVL gene was infrequent (3·7%, 95% CI 2·4-5·6). Genotyping identified 234 spa-types that mapped to 22 clonal complexes. Comparison of these current data with previous work suggest that the widespread use of staphylococcal decolonization regimens over the past decade or more has not had an adverse impact on resistance rates, PVL carriage or the prevalence of specific S. aureus lineages.

Cohort study of a dual-pathogen point source outbreak associated with the consumption of chicken liver pâté, UK, October 2009.

BACKGROUND: In October 2009, a dual-pathogen outbreak of Campylobacter and Salmonella occurred in which 59 cases were identified among guests attending a regional conference in the North of England. The mean symptomatic period was 5.4 days ( confidence intervals: 4.4-6.4), and over 84% of the cases had abdominal pain and diarrhoea. METHODS: A retrospective cohort study was used to investigate the outbreak, and active case-finding was performed through the conference organizers and environmental health officers. A focused questionnaire was distributed to all guests via the event organizers 10 days after the conference. RESULTS: Response rate among guests was 61% (107/175). A cohort study was undertaken, and a strong association was found between illness and consumption of chicken liver pâté, supporting the hypothesis that chicken liver pâté was the most likely cause of the outbreak. CONCLUSION: This is the first mixed pathogen outbreak documented associated with the consumption of chicken liver pâté and adds to the evidence of potential hazards associated with the undercooking of poultry livers. A rapid outbreak investigation with collaboration between several organizations and the venue led to identification of the most probable source.

Malaria prophylaxis in travellers from Britain.

A short questionnaire about malarial prophylaxis was completed by 376 travellers departing from Gatwick Airport to destinations in Asia, Africa, Australasia and South or Central America. Only 263 (70%) had sought advice, 80% of them from a general practitioner. Of travellers born in Britain, 81% had sought advice compared to 38% of those born abroad (P less than 0.001). Advice about protective measures to reduce mosquito bites had been given to 52% travellers. Although 264 were travelling to areas where prophylaxis is advised, only 167 (63%) were taking antimalarials, while 22% travelling to malaria-free destinations were taking unnecessary prophylaxis. Many British travellers do not take effective antimalarial chemoprophylaxis. This has undoubtedly contributed to the recent increase in incidence of the disease in the U.K. General practitioners should ensure that they give correct advice and the immigrant population need to understand the risk of malaria when they return home.